Peds Week 2

Which statement best describes development in infants and children?
a. Development, a predictable and orderly process, occurs at varying rates within
normal limits.
b. Development is primarily related to the growth in the number and size of cells.
c. Development occurs in a proximodistal direction with fine muscle development
occurring first.
d. Development is more easily and accurately measured than growth.

ANS: A
Feedback
A Development, a continuous and orderly process, provides the basis for increases
in the child's function and complexity of behavior. The increases in rate of
function and complexity can vary normally within limits for each child.
B An increase in the number and size of cells is a definition for growth.
C Development proceeds in a proximodistal direction with fine muscle
organization occurring as a result of large muscle organization.
D Development is a more complex process that is affected by many factors;
therefore, it is less easily and accurately measured. Growth is a predictable
process with standard measurement methods.

Frequent developmental assessments are important for which reason?
a. Stable developmental periods during infancy provide an opportunity to identify
any delays or deficits.
b. Infants need stimulation specific to the stage of development.
c. Critical periods of development occur during childhood.
d. Child development is unpredictable and needs monitoring.

ANS: C
Feedback
A Infancy is a dynamic time of development that requires frequent evaluations to
assess appropriate developmental progress.
B Infants in a nurturing environment will develop appropriately and will not
necessarily need stimulation specific to their developmental stage.
C Critical periods are blocks of time during which children are ready to master
specific developmental tasks. The earlier those delays in development are
discovered and intervention initiated, the less dramatic their effect will be.
D Normal growth and development is orderly and proceeds in a predictable pattern
based on each individual's abilities and potentials.

Which factor has the greatest influence on child growth and development?
a. Culture
b. Environment
c. Genetics
d. Nutrition

ANS: C
Feedback
A Culture is a significant factor that influences how children grow toward
adulthood. Culture influences both growth and development but does not
eliminate inborn genetic influences.
B Environment has a significant role in determining growth and development both
before and after birth. The environment can influence how and to which extent
genetic traits are manifested, but environmental factors cannot eliminate the
effect of genetics.
C Genetic factors (heredity) determine each individual's growth and developmental
rate. Although factors such as environment, culture, nutrition, and family can
influence genetic traits, they do not eliminate the effect of the genetic
endowment, which is permanent.
D Nutrition is critical for growth and plays a significant role throughout childhood.

The nurse is planning a teaching session for a young child and her parents. According to
Piaget's theory, the period of cognitive development in which the child is able to
distinguish between concepts related to fact and fantasy, such as human beings are
incapable of flying like birds, is the \_______ period of cognitive development.
a. Sensorimotor
b. Formal operations
c. Concrete operations
d. Preoperational

ANS: C
Feedback
A The sensorimotor stage occurs in infancy and is a period of reflexive behavior.
During this period, the infant's world becomes more permanent and organized.
The stage ends with the infant demonstrating some evidence of reasoning.
B Formal operations is a period in development in which new ideas are created
through previous thoughts. Analytic reason and abstract thought emerge in this
period.
C Concrete operations is the period of cognitive development in which children's
thinking is shifted from egocentric to being able to see another's point of view.
They develop the ability to distinguish fact from fantasy.
D The preoperational stage is a period of egocentrism in which the child's
judgments are illogical and dominated by magical thinking and animism.

The theorist who viewed developmental progression as a lifelong series of conflicts that
need resolution is
a. Erikson
b. Freud
c. Kohlberg
d. Piaget

ANS: A
Feedback
A Erik Erikson viewed development as a series of conflicts affected by social and
cultural factors. Each conflict must be resolved for the child to progress
emotionally, with unsuccessful resolution leaving the child emotionally disabled.
B Sigmund Freud proposed a psychosexual theory of development. He proposed
that certain parts of the body assume psychological significance as foci of sexual
energy. The foci shift as the individual moves through the different stages (oral,
anal, phallic, latency, and genital) of development.
C Lawrence Kohlberg described moral development as having three levels
(preconventional, conventional, and postconventional). His theory closely
parallels Piaget's.
D Jean Piaget's cognitive theory interprets how children learn and think and how
this thinking progresses and differs from adult thinking. Stages of his theory
include sensorimotor, preoperations, concrete operations, and formal operations.

What does the nurse need to know when observing a chronically ill child at play?
a. Play is not important to hospitalized children.
b. Children need to have structured play periods.
c. Children's play is a form of communication.
d. Play is to be discouraged because it tires hospitalized children.

ANS: C
Feedback
A Play is important to all children in all environments. Play for children is a
mechanism for mastering their environment.
B Although children's play activities appear to be unorganized and at times
chaotic, play has purpose and meaning. Imposing structure on play interferes
with the tasks being worked on.
C Play for all children is an activity woven with meaning and purpose. For
chronically ill children, play can indicate their state of wellness and response to
treatment. It is a way to express joy, fear, anxiety, and disappointments.
D Children who have fewer energy reserves still require play. For these children,
less-active play activities will be important.

Which child is most likely to be frightened by hospitalization?
a. A 4-month-old infant admitted with a diagnosis of bronchiolitis
b. A 2-year-old toddler admitted for cystic fibrosis
c. A 9-year-old child hospitalized with a fractured femur
d. A 15-year-old adolescent admitted for abdominal pain

ANS: B
Feedback
A Young infants are not as likely to be as frightened as toddlers by hospitalization
because they are not as aware of the environment.
B Toddlers are most likely to be frightened by hospitalization because their thought
processes are egocentric, magical, and illogical. They feel very threatened by
unfamiliar people and strange environments.
C The 9-year-old child's cognitive ability is sufficient enough for the child to
understand the reason for hospitalization.
D The 15-year-old adolescent has the cognitive ability to interpret the reason for
hospitalization.

Which expected outcome is developmentally appropriate for a hospitalized 4-year-old
child?
a. The child will be dressed and fed by the parents.
b. The child will independently ask for play materials or other personal needs.
c. The child will be able to verbalize an understanding of the reason for the
hospitalization.
d. The child will have a parent stay in the room at all times.

ANS: B
Feedback
A Parents need to foster appropriate developmental behavior in the 4-year-old
child. Dressing and feeding the child do not encourage independent behavior.
B Erikson identifies initiative as a developmental task for the preschool child.
Initiating play activities and asking for play materials or assistance with personal
needs demonstrates developmental appropriateness.
C A 4-year-old child cannot be expected to cognitively understand the reason for
hospitalization. Expecting the child to verbalize an understanding for
hospitalization is an inappropriate outcome.
D Parents staying with the child throughout a hospitalization is an inappropriate
outcome. Although children benefit from parental involvement, parents may not
have the support structure to stay in the room with the child at all times.

A preschool aged child will be receiving immunizations. Which statement identifies an
appropriate level of language development for a 4-year-old child?
a. The child has a vocabulary of 300 words and uses simple sentences.
b. The child uses correct grammar in sentences.
c. The child is able to pronounce consonants clearly.
d. The child uses language to express abstract thought.

ANS: B
Feedback
A Simple sentences and a 300-word vocabulary are appropriate for a 2-year-old
child.
B The 4-year-old child is able to use correct grammar in sentence structure.
C The 4-year-old child typically has difficulty in pronouncing consonants.
D The use of language to express abstract thought is developmentally appropriate
for the adolescent

Which children are at greater risk for not receiving immunizations?
a. Children who attend licensed daycare programs
b. Children entering school
c. Children who are home schooled
d. Young adults entering college

ANS: C
Feedback
A All states require immunizations for children in daycare programs.
B All states require immunizations for children entering school.
C Home-schooled children are at risk for being underimmunized and need to be
monitored.
D Most colleges require a record of immunizations as part of a health history.

Which developmental assessment instrument is appropriate to assess a 5-year-old child?
a. Brazelton Behavioral Scale
b. Denver Developmental Screening Test II (DDST-II)
c. Dubowitz Scale
d. New Ballard Scale

ANS: B
Feedback
A The Brazelton Behavioral Scale is used for newborn assessment.
B The DDST-II is used for infants and children between birth and 6 years of age.
C The Dubowitz Scale is used for estimation of gestational age.
D The New Ballard Scale is used for newborn screening.

A 2-month-old child has not received any immunizations. Which immunizations should
the nurse give?
a. DTaP, Hib, HepB, MCV, varicella
b. DTaP, Hib, HepB, HPV, IPV, Rota
c. DTaP, Hib, HepB, PCV, Rota
d. DTaP, Hib, HepB, PCV, HepA

ANS: C
Feedback
A Meningococcal vaccine should be administered to children at 11 to 12 years of
age.
B Human papillomavirus vaccine is administered to adolescent girls only.
C DTaP, Hib, HepB, PCV, IPV, and Rota are appropriate immunizations for an
unimmunized 2-month-old child.
D HepA is recommended for all children at 1 year of age.

The environment, both physical and psychosocial, is a significant determinate of growth
and development outcomes before and after birth. Nurses can assist parents in preventing
environmental injury for their 2-year-old toddler by teaching them to avoid the most
common sources of exposure. This anticipatory guidance includes teaching related to
a. Avoiding sun exposure, secondhand smoke, and lead
b. Socioeconomic status, primarily poverty
c. Maternal smoking and alcohol intake during pregnancy
d. The passing of environmental toxins through breast milk

ANS: A
Feedback
A Lead can be present in the home and in toys made overseas. Environmental
injury can also be the result of mercury, pesticides (flea and tick collars), radon,
and exposure to the sun and secondhand smoke. It is important for the nurse to
provide health teaching related to these factors.
B The nurse is unable to influence socioeconomic status.
C It is too late for the nurse to instruct the mother regarding smoking or alcohol
intake during pregnancy. This should have been included in prenatal teaching.
D It is unlikely that a 2-year-old child will still be breastfeeding.

Which immunizations should be used with caution in children with an allergy to eggs?
a. HepB
b. DTaP
c. Hib
d. MMR

ANS: D
Feedback
A HepB is safe for children with an egg allergy.
B DTaP is safe for children with an egg allergy.
C Hib is safe for children with an egg allergy.
D Live measles vaccine is produced by using chick embryo cell culture, so there is
a remote possibility of anaphylactic hypersensitivity in children with egg
allergies. Most reactions are actually the result of other components in the
vaccine.

When counseling parents and children about the importance of increased physical activity,
the nurse can emphasize
a. Anaerobic exercise should comprise a major component of the child's daily
exercise.
b. All children should be physically active for at least 2 hours per day.
c. It is not necessary to participate in physical education classes at school if a student
is taking part in other activities.
d. Making exercise fun and a habitual activity.

ANS: D
Feedback
A Aerobic exercise should comprise a major component of children's daily
exercise; however, physical activity should also include muscle and bone
strengthening activities.
B Children and adolescents should be physically active for at least 1 hour daily.
C Encourage all student to participate fully in any physical education classes.
D It is important to make exercise a fun and a habitual activity. Encourage parents
to investigate their community's different activity programs. This includes
recreation centers, parks, and the YMCA.

Which is the preferred site for administration of the Hib vaccine to an infant?
a. Deltoid
b. Anterolateral thigh
c. Upper, outer aspect of the arm
d. Dorsal gluteal region

ANS: B
Feedback
A The deltoid muscle is not used for infants.
B The anterolateral thigh is the preferred site for intramuscular administration of
vaccines for infants.
C Subcutaneous injections can be given in the upper arm. The HIB vaccine is given
by the intramuscular route.
D The dorsal gluteal site is never used for vaccines.

What should the nurse evaluate before administering the Denver Developmental Screening
Test II (DDST-II)? Select all that apply.
a. The child's height and weight
b. The parent's ability to comprehend the results
c. The child's mood
d. The parent-child interaction
e. The child's chronologic age

ANS: C, E
Feedback
Correct: The results of the screening test are valid if the child acted in a normal and
expected manner. The child's chronologic age in years, months, and days
must be calculated in order to draw the age line. This is necessary in order
to perform an accurate DDST-II. Reliability and validity of the test can be
altered if the child is not feeling well or is under the influence of
medications.
Incorrect: The child's height and weight are not relevant to the DDST-II screening
process. The parent's ability to understand the results of the screening is
not relevant to the validity of the test. The parent-child interaction is not
significantly relevant to the test results.

You are preparing immunizations for a 12-month-old child who is immunocompromised.
Which immunizations cannot be given? Select all that apply.
a. DTaP
b. HepA
c. IPV
d. Varicella
e. MMR

ANS: D, E
Feedback
Correct: Children who are immunologically compromised should not receive live
viral vaccines. Varicella is a live vaccine and should not be given except in
special circumstances. MMR is a live vaccine and should not be given to
immunologically compromised children.
Incorrect: DTaP, HepA, and IPV can be given safely.

Breastfeeding is the ideal method for providing nutrition to the human infant and is
recommended by the American Heart Association, the American Academy of Pediatrics,
and the World Health Organization. Infants should be exclusively breastfed for a minimum
of 4 months and preferably 6 months. Is this statement true or false?

ANS: T
This statement is correct. Solid food should not be introduced until 4 to 6 months of age.
Breastfeeding should accompany solid food introduction until 1 year of age.

A type of play that allows children to act out roles and experiences that may have
happened to them, that they fear may happen, or that they have observed in others is
known as \______ play.

ANS:
dramatic
This type of play can be spontaneous or guided and often includes medical or nursing
equipment. It is especially valuable for children who have had or will have multiple
procedures or hospitalizations.

Which milestone is developmentally appropriate for a 2-month-old infant?

a. Pulled to a sitting position, head lag is absent.

b. Pulled to a sitting position, the infant is able to support the head when the trunk is lifted.

c. The infant can lift his or her head from the prone position and briefly hold the head erect.

d. In the prone position, the infant is fully able to support and hold the head in a straight line.

ANS: C

Rationale: A 2-month-old infant is able to briefly hold the head erect when in a prone position. If a parent were holding the infant against the parents shoulder, the infant would be able to lift his or her head briefly.

Approximately how much would a newborn who weighed 7 pounds 6 ounces at birth weigh at 1 year of age?

a. 14 3/4 lb

b. 22 1/8 lb

c. 29 1/2 lb

d. Unable to estimate weigh at 1 year

ANS: B

Rationale:
An infant triples birth weight by 1 year of age.

Which statement made by a mother is consistent with a developmental delay?

a. I have noticed that my 9-month-old infant responds consistently to the sound of his name.

b. I have noticed that my 12-month-old child does not get herself to a sitting position or pull to stand.

c. I am so happy when my 1 1/2-month-old infant smiles at me.

d. My 5-month-old infant is not rolling over in both directions yet.

ANS: B

Critical developmental milestones for gross motor development in a 12-month-old include standing briefly without support, getting to a sitting position, and pulling to stand. If a 12-month-old child does not perform these activities, it may be indicative of a developmental delay.

The nurse is performing a routine assessment on a 14-month-old infant and notes that the anterior fontanel is closed. This should be interpreted as a(n)

a. Normal finding

b. Questionable finding infant should be rechecked in 1 month

c. Abnormal finding indicates need for immediate referral to practitioner

d. Abnormal finding indicates need for developmental assessment

ANS: A

Rationale:
This is a normal finding. The anterior fontanel closes between ages 12 and 18 months. The posterior fontanel closes between 2 and 3 months of age

The nurse advises the mother of a 3-month-old exclusively breastfed infant to

a. Start giving the infant a vitamin D supplement.

b. Start using an infant feeder and add rice cereal to the formula.

c. Start feeding the infant rice cereal with a spoon at the evening feeding.

d. Continue breastfeeding without any supplements.

ANS: A

Rationale:
Breast milk does not provide an adequate amount of dietary vitamin D. Infants who are exclusively breastfed need vitamin D supplements to prevent rickets.

At what age is an infant first expected to locate an object hidden from view?

a. 4 months of age

b. 6 months of age

c. 9 months of age

d. 20 months of age

ANS: C

Rationale: By 9 months of age, an infant will actively search for an object that is out of sight.

The parents of a newborn infant state, We will probably not have our baby immunized because we are concerned about the risk of our child being injured. What is the nurses best response?

a. It is your decision.

b. Have you talked with your parents about this? They can probably help you think about this decision.

c. The risks of not immunizing your baby are greater than the risks from the immunizations.

d. You are making a mistake.

ANS: C

Rationale:
Although immunizations have been documented to have a negative effect in a small number of cases, an unimmunized infant is at greater risk for development of complications from childhood diseases than from the vaccines.

The mother of a 9-month-old infant is concerned because the infant cries when approached by an unknown shopper at the grocery store. What is the best response for the nurse to make to the mother?

a. You could consider leaving the infant more often with other people so he can adjust.

b. You might consider taking him to the doctor because he may be ill.

c. Have you noticed whether the baby is teething?

d. This is a sign of stranger anxiety and demonstrates healthy attachment.

ANS: D

Rationale: The nurse can reassure parents that healthy attachment is manifested by stranger anxiety in late infancy.

Which statement concerning physiologic factors is true?

a. The infant has a slower metabolic rate than an adult.

b. An infant has an inability to digest protein and lactase.

c. Infants have a slower circulatory response than adults do.

d. The kidneys of an infant are less efficient in concentrating urine than an adults kidneys.

ANS: D

Rationale: The infants kidneys are not as effective at concentrating urine compared with an adults because of immaturity of the renal system and slower glomerular filtration rates. This puts the infant at greater risk for fluid and electrolyte imbalance.

Which is a priority in counseling parents of a 6-month-old infant?

a. Increased appetite from secondary growth spurt

b. Encouraging the infant to smile

c. Securing a developmentally safe environment for the infant

d. Strategies to teach infants to sit up

ANS: C

Rationale:
Safety is a primary concern as an infant becomes increasingly mobile.

A mother of a 2-month-old infant tells the nurse, My child doesnt sleep as much as his older brother did at the same age. What is the best response for the nurse?

a. Have you tried to feed the baby more often?

b. Infant sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time.

c. It is helpful to keep a record of your babys eating, waking, sleeping, and elimination patterns and to come back in a week to discuss them.

d. This infant is difficult. It is important for you to identify what is bothering the baby.

ANS: B

Rationale: Newborn infants may sleep as much as 17 to 20 hours per day. Sleep patterns vary widely, with some infants sleeping only 2 to 3 hours at a time.

he mother of a 10-month-old infant tells the nurse that her infant really likes cows milk. What is the nurses best response to this mother?

a. Milk is good for him.

b. It is best to wait until he is a year old before giving him cows milk.

c. Limit cows milk to his bedtime bottle.

d. Mix his cereal with cows milk and give him formula in a bottle.

ANS: B

Rationale: It is best to wait until the infant is at least 1 year old before giving him cows milk because of the risk of allergies and intestinal problems. Cows milk protein intolerance is the most common food allergy during infancy.

The mother of a 10-month-old infant asks the nurse about beginning to wean her child from his bottle. Which statement by the mother suggests that the child is not ready to be weaned?

a. My son is frequently throwing his bottle down.

b. The baby takes a few ounces of formula from the bottle.

c. He is constantly chewing on the nipple. It concerns me.

d. He consistently is sucking.

ANS: D

Rationale:
Consistent sucking is a sign that the child is not ready to be weaned.

Which is appropriate play for a 6-month-old infant?

a. Pat-a-cake, peek-a-boo

b. Ball rolling, hide-and-seek game

c. Bright rattles and tactile toys

d. Push and pull toys

ANS: A

Rationale:
b\=9 mon
c\=4 mon
d\= 12 mon

Which statement by a mother indicates that her 5-month-old infant is ready for solid food?

a. When I give my baby solid foods, she has difficulty getting it to the back of her throat to swallow.

b. She has just started to sit up without any support.

c. I am surprised that she weighs only 11 pounds. I expected her to have gained some weight.

d. I find that she really has to be encouraged to eat.

ANS: B

Rationale: Sitting is a sign that the child is ready to begin with solid foods.

A mother asks the nurse, When should I begin to clean my babys teeth? What is the best response for the nurse to make?

a. You can begin when all her baby teeth are in.

b. You can easily begin now. Just put some toothpaste on a gauze pad to clean the teeth.

c. I dont think you have to worry about that until she can handle a toothbrush.

d. You can begin as soon as your child has a tooth. The easiest way is to take cotton swabs or a face cloth and just wipe the teeth. Toothpaste is not necessary.

ANS: D

Rationale:
An infants teeth need to be cleaned as soon as they erupt. Cleaning the teeth with cotton swabs or a face cloth is appropriate.

A 3-month-old infant born at 38 weeks of gestation will hold a rattle if it is put in her hands, but she will not voluntarily grasp it. The nurse should interpret this as

a. Normal development

b. Significant developmental lag

c. Slightly delayed development as a result of prematurity

d. Suggestive of a neurologic disorder such as cerebral palsy

ANS: A

Rationale: This is indicative of normal development. Reflexive grasping occurs during the first 2 to 3 months and then gradually becomes voluntary.

In terms of fine motor development, what should the 7-month-old infant be able to do?

a. Transfer objects from one hand to the other.

b. Use thumb and index finger in crude pincer grasp.

c. Hold crayon and make a mark on paper.

d. Release cubes into a cup.

ANS: A

Rationale:
b\=9 mon
c\= 15 mon
d\= 12 mon

In terms of gross motor development, what would the nurse expect a 5-month-old infant to do?

a. Roll from abdomen to back.

b. Roll from back to abdomen.

c. Sit erect without support.

d. Move from prone to sitting position.

ANS: A

Rationale:
b\= 6 mon
c\= 8 mon
d\=10 mon

According to Piaget, the 6-month-old infant is in what stage of the sensorimotor phase?

a. Use of reflexes

b. Primary circular reactions

c. Secondary circular reactions

d. Coordination of secondary schemata

ANS: C

Rationale: Infants are usually in the secondary circular reaction stage from age 4 months to 8 months. This stage is characterized by a continuation of the primary circular reaction because of the response that results. Shaking is performed to hear the noise of the rattle, not just for shaking.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. The nurse should recommend that the infant be given

a. Skim milk

b. Whole cows milk

c. Commercial iron-fortified formula

d. Commercial formula without iron

ANS: C

Rationale: For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used.

The parent of 2-week-old Sarah asks the nurse whether Sarah needs fluoride supplements, because she is exclusively breastfed. The nurses best response is

a. She needs to begin taking them now.

b. They are not needed if you drink fluoridated water.

c. She may need to begin taking them at age 6 months.

d. She can have infant cereal mixed with fluoridated water instead of supplements.

ANS: C

Fluoride supplementation is recommended by the American Academy of Pediatrics beginning at age 6 months if the child is not drinking adequate amounts of fluoridated water.

A nurse has completed a teaching session for parents about baby-proofing the home. Which statements made by the parents indicate an understanding of the teaching? Select all that apply.

a. We will put plastic fillers in all electrical plugs.

b. We will place poisonous substances in a high cupboard.

c. We will place a gate at the top and bottom of stairways.

d. We will keep our household hot water heater at 130 degrees.

e. We will remove front knobs from the stove.

ANS: A, C, E

Rationale: Correct- By the time babies reach 6 months of age, they begin to become much more active, curious, and mobile. Putting plastic fillers on all electrical plugs can prevent an electrical shock. Putting gates at the top and bottom of stairways will prevent falls. Removing front knobs form the stove can prevent burns.

Incorrect- Poisonous substances should be stored in a locked cabinet not in a cabinet that children can reach when they begin to climb. The household hot water heater should be turned down to 120 degrees or less.

Hearing seems to be relatively acute, even at birth, as shown by reflexive generalized reaction to noise. All newborns should undergo hearing screening at birth, before hospital discharge. In addition, assessment for hearing deficits should take place at every well-baby visit. Risk factors for hearing loss include (select all that apply)

a. Structural abnormalities of the ear

b. Family history of hearing loss

c. Alcohol or drug use by the mother during pregnancy

d. Gestational diabetes

e. Trauma

ANS: A, B, E

Rationale: Correct- Structural abnormalities of the ear, a family history of hearing loss, and trauma are risk factors for hearing loss. Other risk factors include persistent otitis media and developmental delay. The American Academy of Pediatrics suggests that infants who demonstrate hearing loss be eligible for early intervention and specialized hearing and language services.

Incorrect- Prenatal alcohol or drug intake and gestational diabetes are not risk factors for hearing loss in the infant.

The nurse has just assisted in the delivery of a female infant to first-time parents.

The infant is suctioned, dried, and placed skin-to-skin on her mothers chest. This allows for significant interaction between mother and baby and is known as \_____________.

attachment

Rationale: Parent-infant attachment is one of the most important aspects of infant psychosocial development. Initiated immediately after birth, attachment is strengthened by many mutually satisfying interactions between parents and their infant during the first few months of life. Attachment is a sense of belonging or connection with each other.

The rate of Sudden Infant Death Syndrome (SIDS), now the third leading cause of death in infants, has increased despite international efforts and the Back to Sleep campaign. Is this statement true or false?

FALSE

Rationale: This statement is incorrect. SIDS, which for a long time was the second leading cause of infant deaths, has decreased in part because of the Back to Sleep program. It is important for both hospital and clinic nurses to educate parents on safe sleep strategies for their infant.

The mother of a 14-month-old child is concerned because the child's appetite has decreased. The best response for the nurse to make to the mother is:
a. "It is important for your toddler to eat three meals a day and nothing in between."
b. "It is not unusual for toddlers to eat less."
c. "Be sure to increase your child's milk consumption, which will improve nutrition."
d. "Giving your child a multivitamin supplement daily will increase your toddler's appetite."

ANS: B
A Toddlers need small, frequent meals. Nutritious selection throughout the day, rather than quantity, is more important with this age-group.
B Physiologically, growth slows and appetite decreases during the toddler period.
C Milk consumption should not exceed 16 to 24 oz daily. Juice should be limited to 4 to 6 oz per day. Increasing the amount of milk will only further decrease solid food intake.
D Supplemental vitamins are important for all children, but they do not increase appetite.

Which toy is the most developmentally appropriate for an 18- to 24-month-old child?
a. A push-and-pull toy
c. A bicycle with training wheels
b. Nesting blocks
d. A computer

ANS: A
A Push-and-pull toys encourage large muscle activity and are appropriate for toddlers.
B Nesting blocks are more appropriate for a 12- to 15-month-old child.
C A bicycle with training wheels is appropriate for a preschool or young school-age child.
D A computer can be appropriate as early as the preschool years.

Which is the priority concern in developing a teaching plan for the parents of a 15-month-old child?
a. Toilet training guidelines
b. Guidelines for weaning children from bottles
c. Instructions on preschool readiness
d. Instructions on a home safety assessment

ANS: D
A Although it is appropriate to give parents of a 15-month-old child toilet training guidelines, the child is not usually ready for toilet training, so it is not the priority teaching intervention.
B Parents of a 15-month-old child should have been advised to beginning weaning from the breast or bottle at 6 to 12 months of age.
C Educating a parent about preschool readiness is important and can occur later in the parents' educational process. The priority teaching intervention for the parents of a 15-month-old child is the importance of a safe environment.
D Accidents are the major cause of death in children, including deaths caused by ingestion of poisonous materials. Home and environmental safety assessments are priorities in this age-group because of toddlers' increased motor skills and independence, which puts them at greater risk in an unsafe environment.

What is the primary purpose of a transitional object?
a. It helps the parents deal with the guilt they feel when they leave the child.
b. It keeps the child quiet at bedtime.
c. It is effective in decreasing anxiety in the toddler.
d. It decreases negativism and tantrums in the toddler.

ANS: C
A A decrease in parental guilt (distress) is an indirect benefit of a transitional object.
B A transitional object may be part of a bedtime ritual, but it may not keep the child quiet at bedtime.
C Decreasing anxiety, particularly separation anxiety, is the function of a transitional object; it provides comfort to the toddler in stressful situations and helps make the transition from dependence to autonomy.
D A transitional object does not significantly affect negativity and tantrums, but it can comfort a child after tantrums.

Which statement best identifies the characteristics of language development in a toddler?
a. Language development skills slow during the toddler period.
b. The toddler understands more than he can express.
c. Most of the toddler's speech is not easily understood.
d. The toddler's vocabulary contains approximately 600 words.

ANS: B
A Although language development varies in relationship to physical activity, language skills are rapidly accelerating by 15 to 24 months of age.
B The toddler's ability to understand language (receptive language) exceeds the child's ability to speak it (expressive language).
C By 2 years of age, 60% to 70% of the toddler's speech is understandable.
D The toddler's vocabulary contains approximately 300 or more words.

A mother asks when toilet training is most appropriately initiated. What would be the nurse's best response?
a. "When your child is 12 to 18 months of age."
b. "When your child exhibits signs of physical and psychological readiness."
c. "When your child has been walking for 9 months."
d. "When your child is able to sit on the 'potty' for 10 to 15 minutes."

ANS: B
A Toilet training is not arbitrarily started at 12 to 18 months of age. The child needs to demonstrate signs of bowel or bladder control before attempting toilet training. The average toddler is not ready until 18 to 24 months of age. Waiting until 24 to 30 months of age makes the task easier; toddlers are less negative, more willing to control their sphincters, and want to please their parents.
B Neurologic development is completed at approximately 18 months of age. Parents need to know that both physical and psychological readiness are necessary for toilet training to be successful.
C One of the physical signs of readiness for toilet training is that the child has been walking for 1 year.
D The ability to sit on the "potty" for 10 to 15 minutes may demonstrate parental control rather than being a sign of developmental readiness for toilet training.

Which statement by a mother of a toddler indicates a correct understanding of the use of discipline?
a. "I always include explanations and morals when I am disciplining my toddler."
b. "I always try to be consistent when disciplining the children, and I correct my children at the time they are misbehaving."
c. "I believe that discipline should only be done by one family member."
d. "My rule of thumb is no more than one spanking a day."

ANS: B
A The toddler's cognitive level of development precludes the use of explanations and morals as a part of discipline.
B Consistent and immediate discipline for toddlers is the most effective approach. Unless disciplined immediately, the toddler will have difficulty connecting the discipline with the behavior.
C Discipline for the toddler should be immediate; therefore the family member caring for the child should provide discipline to the toddler when it is necessary.
D Discipline is required for unacceptable behavior, and the one-spanking-a-day rule contradicts the concept of a consistent response to inappropriate behavior. Additionally, spanking is an inappropriate method of disciplining a child.

Which comments indicate that the mother of a toddler needs further teaching about dental care?
a. "We use well water so I give my toddler fluoride supplements."
b. "My toddler brushes his teeth with my help."
c. "My child will not need a dental checkup until his permanent teeth come in."
d. "I use a small nylon bristle brush for my toddler's teeth."

ANS: C
A Toddlers need fluoride supplements when they use a water supply that is not fluorinated.
B Toddlers need supervision with dental care. The parent should finish brushing areas not reached by the child.
C Children should first see the dentist 6 months after the first primary tooth erupts and no later than age 30 months.
D A small nylon bristle brush works best for cleaning toddlers' teeth.

Which assessment finding in a preschooler would suggest the need for further investigation?
a. The child is able to dress independently.
b. The child rides a tricycle.
c. The child has an imaginary friend.
d. The child has a 2-lb weight gain in 12 months.

ANS: D
A A preschool child should be able to dress independently.
B A preschool child should be able to ride a tricycle.
C Imaginary friends are common for preschoolers.
D Preschool children gain an average of 5 pounds a year. A gain of only 2 pounds is less than half of the expected weight gain and should be investigated.

Which is the most appropriate action for the nurse to take when telling a preschool child about an upcoming procedure?
a. Explain all the information in detail to the child.
b. Speak loudly and clearly to the child.
c. Inform the parents of the procedure and ask them to tell the child.
d. Allow the child to play with medical supplies that may be used during the procedure.

ANS: D
A It is inappropriate to give a preschooler all the information in detail. The child needs to understand what is going to happen to him or her without explicit details of the procedure.
B Speaking in clear sentences with simple words is important, but the conversation should be conducted at a nonthreatening, normal sound level.
C The nurse has the most knowledge and best ability for explaining the procedure to the child; however, the parents can be an important resource when explaining the procedure.
D Symbolic play is important for emotional development because it allows the child to work through distressing feelings and can be therapeutic.

In caring for a 4-year-old child with a diagnosis of suspected child abuse, which is the best nursing intervention?
a. Avoid touching the child.
b. Provide the child with play situations that allow for disclosure.
c. Discourage the child from remembering the incident.
d. Deny the suspected perpetrator visiting rights to the child.

ANS: B
A All children need to be touched. What is important is to tell the child in simple, clear terms what you are doing and why you are doing it. Nurses have the opportunity to teach children the normal, healthy boundaries of their bodies and what constitutes inappropriate behavior.
B Play allows the child to disclose what happened to him or her without having to talk about the incident. Symbolic play is important for emotional development and it allows the child to work through distressing feelings.
C If the child chooses to remember what happened, it is inappropriate to discourage it. It is important to listen to the child in a nonjudgmental way, allowing the child to discuss what happened, to make statements, or to ask questions.
D It is not the nurse's role or responsibility to restrict visitors unless child safety is an issue. The child may be negatively affected if a caregiver, who may be the abuser, does not visit.

What is helpful to tell a mother who is concerned about preventing sleep problems in her 2-year-old child?
a. Have the child always sleep in a quiet, darkened room.
b. Provide high-carbohydrate snacks before bedtime.
c. Communicate with the child's daytime caretaker about eliminating the afternoon nap.
d. Use a nightlight in the child's room.

ANS: D
A A dark, quiet room may be scary to a preschooler.
B High-carbohydrate snacks increase energy and do not promote relaxation.
C Most 2-year-olds take one nap each day. Many give up the habit by age 3. Insufficient rest during the day can lead to irritability and difficulty sleeping at night.
D The preschooler has a great imagination. Sounds and shadows can have a negative effect on sleeping behavior. Nightlights provide the child with the ability to visualize the environment and decrease the fear felt in a dark room.

Which statement, made by a 4-year-old child's father, is true about the care of the preschooler's teeth?
a. "Because the 'baby teeth' are not permanent, they are not important to the child."
b. "My son can be encouraged to brush his teeth after I have thoroughly cleaned his teeth."
c. "My son's 'permanent teeth' will begin to come in at 4 to 5 years of age."
d. "Fluoride supplements can be discontinued when my son's 'permanent teeth' erupt."

ANS: B
A Deciduous teeth are important because they maintain spacing and play an important role in the growth and development of the jaws and face and in speech development.
B Toddlers and preschoolers lack the manual dexterity to remove plaque adequately, so parents must assume this responsibility.
C Secondary teeth erupt at about 6 years of age.
D If the family does not live in an area where fluoride is included in the water supply, fluoride supplements should be continued.

What do parents of preschool children need to understand about discipline?
a. Both parents and the child should agree on the method of discipline.
b. Discipline should involve some physical restriction.
c. The method of discipline should be consistent with the discipline methods of the child's peers.
d. Discipline should include positive reinforcement of desired behaviors.

ANS: D
A Discipline does not need to be agreed on by the child. Preschoolers feel secure with limits and appropriate, consistent discipline. Both parents should be in agreement so that the discipline is consistently applied.
B Discipline does not necessarily need to include physical restriction.
C Discipline does not need to be consistent with that of the child's peers.
D Effective discipline strategies should involve a comprehensive approach that includes consideration of the parent-child relationship, reinforcement of desired behaviors, and consequences for negative behaviors

In providing anticipatory guidance to parents whose child will soon be entering kindergarten, which is a critical factor in preparing a child for kindergarten entry?
a. The child's ability to sit still
b. The child's sense of learned helplessness
c. The parent's interactions and responsiveness to the child
d. Attending a preschool program

ANS: C
A The child's ability to sit still is important to learning; however, parental responsiveness and involvement are more important factors.
B Learned helplessness is the result of a child feeling that he or she has no effect on the environment and that his or her actions do not matter. Parents who are actively involved in a supportive learning environment will demonstrate a more positive approach to learning.
C Interactions between the parent and child are an important factor in the development of academic competence. Parental encouragement and support maximize a child's potential.
D Preschool and daycare programs can supplement the developmental opportunities provided by parents at home, but they are not critical in preparing a child for entering kindergarten.

Which play patterns does a 3-year-old child typically display? (Choose all that apply.)
a. Imaginary play
c. Cooperative play
b. Parallel play
d. Structured play

ANS: A, B, C
Correct A, B, C. Children between ages 3 and 5 years enjoy parallel and associative play. Children learn to share and cooperate as they play in small groups. Play is often imitative, dramatic, and creative. Imaginary friends are common around age 3 years.
Incorrect D. Structured play is typical of school-age children.

Motor vehicle injuries are a significant threat to young children. Knowing this, the nurse plans a teaching session with a toddler's parents on car safety. Which will she teach? (Choose all that apply.)
a. Secure in a forward-facing, upright, car safety seat.
b. Place the car safety seat in the rear seat, behind the driver's seat.
c. Harness safety straps should be fit snugly.
d. Place the car safety seat in the front passenger seat equipped with an airbag.

ANS: A, C
Correct A, C. Toddlers should be secured in a forward-facing, upright, approved car safety seat. Harness straps should be adjusted to provide a snug fit.
Incorrect B, D. The car safety seat should be placed in the middle of the rear seat. Children younger than 13 years should not ride in a front passenger seat that is equipped with an air bag.

The nurse is assessing parental knowledge of temper tantrums. Which are true statements about temper tantrums? (Choose all that apply.)
a. Temper tantrums are a common response to anger and frustration in toddlers.
b. Temper tantrums often include screaming, kicking, throwing things, and head banging.
c. Parents can effectively manage temper tantrums by giving in to the child's demands.
d. Children having temper tantrums should be safely isolated and ignored.

ANS: A, B, D
Correct A, B, D. Temper tantrums are a common response to anger and frustration in toddlers. They occur more often when toddlers are tired, hungry, bored, or excessively stimulated. Tantrums may include screaming, kicking, throwing things, biting themselves, or banging their head. Effective management of tantrums includes safely isolating and ignoring the child.
Incorrect C. The child should learn that nothing is gained by having a temper tantrum. Giving in to the child's demands only increases the behavior.

The nurse is providing anticipatory guidance to parents related to promoting healthy nutrition in their young child. She discusses age-appropriate sequencing of feeding behaviors. Place all of the stages listed below in ascending chronologic order from youngest age progressing to oldest age. Use all options.
a. One (1)
b. Two (2)
c. Three (3)
d. Four (4)


1. Uses a spoon well to feed self

2. Uses a fork well to feed self

3. Begins to eat the same foods as the rest of the family

4. Uses a "sippy cup"

1. ANS: D
NOT: "Sippy cups are introduced before 1 year of age, eating the same foods as the rest of the family at 12 months of age, using a spoon well and holding a cup in one hand by 2 years of age, and using a fork well to feed self by age 3 to 4 years."
2. ANS: C
NOT: "Sippy cups are introduced before 1 year of age, eating the same foods as the rest of the family at 12 months of age, using a spoon well and holding a cup in one hand by 2 years of age, and using a fork well to feed self by age 3 to 4 years."
3. ANS: A
NOT: "Sippy cups are introduced before 1 year of age, eating the same foods as the rest of the family at 12 months of age, using a spoon well and holding a cup in one hand by 2 years of age, and using a fork well to feed self by age 3 to 4 years."
4. ANS: B
NOT: "Sippy cups are introduced before 1 year of age, eating the same foods as the rest of the family at 12 months of age, using a spoon well and holding a cup in one hand by 2 years of age, and using a fork well to feed self by age 3 to 4 years."

The nurse percussing over an empty stomach expects to hear which sound?

a. Tympany

b. Resonance

c. Flatness

d. Dullness

ANS: A

Rationale: Tympany is a high-pitched, loud-intensity sound heard over air-filled body parts such as the stomach and bowel.

You are the nurse admitting a toddler to the pediatric infectious disease unit. What is the single most important component of the childs physical examination?

a. Assessment of heart and lungs

b. Measurement of height and weight

c. Documentation of parental concerns

d. Obtaining an accurate history

ANS: D

Rationale: An accurate history is most helpful in identifying problems and potential problems.

In which section of the health history should the nurse record that the parent brought the infant to the clinic today because of frequent diarrhea?

a. Review of systems

b. Chief complaint

c. Lifestyle and life patterns

d. Health history

ANS: B

Rationale: The chief complaint is documented using the childs or parents words for the reason the child was brought to the health care center.

Which choice includes the components of a complete pediatric history?

a. Statistical information, client profile, health history, family history, review of systems, lifestyle and life patterns

b. Vital signs, chief complaint, and list of previous problems

c. Chief complaint, including body location, quality, quantity, timeframe, and alleviating and aggravating factors

d. Pertinent developmental and family information

ANS: A

Rationale: The identified items are included in a complete pediatric history.

The nurse is performing a comprehensive physical examination on a young child in the hospital. At what age can the nurse expect a childs head and chest circumferences to be almost equal?

a. Birth

b. 6 months

c. 1 year

d. 3 years

ANS: C

Rationale: Head and chest measurements are almost equal at 1 year of age.

An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is to

a. Ask her why she wants to know.

b. Determine why she is so anxious.

c. Explain in simple terms how it works.

d. Tell her she will see how it works as it is used.

ANS: C

Rationale: School-age children require explanations and reasons for everything. They are interested in the functional aspect of all procedures, objects, and activities. It is appropriate for the nurse to explain how equipment works and what will happen to the child.

Which chart should the nurse use to assess the visual acuity of an 8-year-old child?

a. Lea chart

b. Snellen chart

c. HOTV chart

d. Tumbling E chart

ANS: B

Rationale: The Snellen chart is used to assess the vision of children older than 6 years of age.

Which action is appropriate when the nurse is assessing breath sounds of an 18-month-old crying child?

a. Ask the parent to quiet the child so the nurse can listen.

b. Auscultate breath sounds and chart that the child was crying.

c. Encourage the child to play with the stethoscope to distract and to calm down before auscultating.

d. Document that data are not available because of noncompliance.

ANS: C

Rationale: Distracting the child with an interesting activity can assist the child to calm down so an accurate assessment can be made.

The nurse is obtaining vital signs on a 1-year-old child. What is the most appropriate site for assessing the pulse rate?

a. Apical

b. Radial

c. Carotid

d. Femoral

ANS: A

Rationale: Apical pulse rates are taken in children younger than 2 years.

A nurse is reviewing pediatric physical assessment techniques. Which statement about performing a pediatric physical assessment is correct?

a. Physical examinations proceed systematically from head to toe unless developmental considerations dictate otherwise.

b. The physical examination should be done with parents in the examining room for children of any age.

c. Measurement of head circumference is done until the child is 5 years old.

d. The physical examination is done only when the child is cooperative.

ANS: A

Rationale: Physical assessment usually proceeds from head to toe; however, developmental considerations with infants and toddlers dictate that the least threatening assessments be done first to obtain accurate data.

What term should be used in the nurses documentation to describe auscultation of breath sounds that are short, popping, and discontinuous on inspiration?

a. Pleural friction rub

b. Bronchovesicular sounds

c. Crackles

d. Wheeze

ANS: C

Rationale:
Crackles are short, popping, discontinuous sounds heard on inspiration.

Which strategy is the best approach when initiating the physical examination of a 9-month-old male infant?

a. Undress the infant and do a head-to-toe examination.

b. Have the parent hold the child on his or her lap.

c. Put the infant on the examination table and begin assessments at the head.

d. Ask the parent to leave because the infant will be upset.

ANS: B

Rationale: Infants 6 months and older feel stranger anxiety. It is easier to do most of the examination on the parents lap to lessen anxiety.

Which strategy is not always appropriate for pediatric physical examination?

a. Take the history in a quiet, private place.

b. Examine the child from head to toe.

c. Exhibit sensitivity to cultural needs and differences.

d. Perform frightening procedures last.

ANS: B

Rationale: The classic approach to physical examination is to begin at the head and proceed through the entire body to the toes. When examining a child, however, the examiner must tailor the physical assessment to the childs age and developmental level.

Which assessment should the nurse perform last when examining a 5-year-old child?

a. Heart

b. Lungs

c. Abdomen

d. Throat

ANS: D

Rationale: Examination of the mouth and throat is considered to be more invasive than other parts of a physical examination. For preschool children, invasive procedures should be left to the end of the examination.

When is the most appropriate time to inspect the genital area during a well-child examination of a 14-year-old girl?

a. It is not necessary to inspect the genital area.

b. Examine the genital area first.

c. After the abdominal assessment.

d. Do the genital inspection last.

ANS: C

Rationale: It is best to incorporate the genital assessment into the middle of the examination. This allows ample time for questions and discussion. If possible, proceed from the abdominal area to the genital area.

Which measurement is not indicated for a 4-year-old well-child examination?

a. Blood pressure

b. Weight

c. Height

d. Head circumference

ANS: D

Rationale: Head circumference is measured on all children from birth to 3 years. Children older than 3 years of age with questionable head size or a history of megalocephaly, hydrocephalus, or microcephaly should have their head circumference assessed at every visit. A 4-year-old without a history of these problems does not need his or her head circumference measured.

The nurse inspecting the skin of a dark-skinned child notices an area that is a dusky red or violet color. This skin coloration is associated with what?

a. Cyanosis

b. Erythema

c. Vitiligo

d. Nevi

ANS: B

Rationale: In dark-skinned children, erythema appears as dusky red or violet skin coloration.

The nurse palpated the anterior fontanel of a 14-month-old infant and found that it was closed. What does this finding indicate?

a. This is a normal finding.

b. This finding indicates premature closure of cranial sutures.

c. This is abnormal and the child should have a developmental evaluation.

d. This is an abnormal finding and the child should have a neurologic evaluation.

ANS: A

Rationale: The anterior fontanel should be completely closed by 12 to 18 months of age.

The nurse is assessing a 4-year-old childs visual acuity. He is planning to attend preschool next week. The results indicate a visual acuity of 20/40 in both eyes. The childs father asks the nurse about his sons results. Which response, if made by the nurse, is correct?

a. Your child will need a referral to the ophthalmologist before he can attend preschool next week.

b. Your childs visual acuity is normal for his age.

c. The results of this test indicate your child may be color blind.

d. Your child did not pass the screening test. He will need to return within the next few weeks to be reevaluated.

ANS: B

Rationale: this is the correct response

When interviewing the mother of a 3-year-old child, the nurse asks about developmental milestones such as the age of walking without assistance. This should be considered

a. Unnecessary information, because the child is 3 years old

b. An important part of the family history

c. An important part of the childs past growth and development

d. An important part of the childs review of systems

ANS: C

Rationale: Information about the attainment of developmental milestones is important to obtain. It provides data about the childs growth and development that should be included in the history.

Which cranial nerve is assessed when the child is asked to imitate the examiners wrinkled frown, wrinkled forehead, smile, and raised eyebrow?

a. Accessory

b. Hypoglossal

c. Trigeminal

d. Facial

ANS: D

Rationale: The facial nerve is assessed as described in the question.

Which assessment finding is considered a neurologic soft sign in a 7-year-old child?

a. Plantar reflex

b. Poor muscle coordination

c. Stereognostic function

d. Graphesthesia

ANS: B

Rationale: Poor muscle coordination is a neurologic soft sign.

Which parameter correlates best with measurements of the bodys total muscle-mass to fat ratio?

a. Height

b. Weight

c. Skin-fold thickness

d. Mid arm circumference

ANS: D

Rationale: Mid arm circumference is correlated with measurements of total muscle mass. Muscle serves as the bodys major protein reserve and is considered an index of the bodys protein stores

Which tool measures body fat most accurately?

a. Stadiometer

b. Calipers

c. Cloth tape measure

d. Paper or metal tape measure

ANS: B

Rationale:
Calipers are used to measure skin-fold thickness, which is an indicator of body fat content.

When palpating the childs cervical lymph nodes, the nurse notes that they are tender, enlarged, and warm. What is the best explanation for this?

a. Some form of cancer

b. Local scalp infection common in children

c. Infection or inflammation distal to the site

d. Infection or inflammation close to the site

ANS: D

Rationale: Small nontender nodes are normal. Tender, enlarged, and warm lymph nodes may indicate infection or inflammation close to their location.

What heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood?

a. S1, S2

b. S3, S4

c. Murmur

d. Physiologic splitting

ANS: C

Rationale: Murmurs are the sounds that are produced in the heart chambers or major arteries from the purulence of blood flow. Murmurs create a blowing and swooshing sound.

Examination of the abdomen is performed correctly by the nurse in which order?

a. Inspection, palpation, and auscultation

b. Palpation, inspection, and auscultation

c. Palpation, auscultation, and inspection

d. Inspection, auscultation, and palpation

ANS: D

Rationale: The correct order of abdominal examination is inspection, auscultation, and palpation.

The nurse has a 2-year-old boy sit in tailor position during palpation for the testes. What is the rationale for this position?

a. It prevents cremasteric reflex.

b. Undescended testes can be palpated.

c. This tests the child for an inguinal hernia.

d. The child does not yet have a need for privacy.

ANS: A

Rationale: The tailor position stretches the muscle responsible for the cremasteric reflex. This prevents its contraction, which pulls the testes into the pelvic cavity.

During examination of a toddlers extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is

a. Abnormal, requiring further investigation

b. Abnormal unless it occurs in conjunction with knock-knee

c. Normal if the condition is unilateral or asymmetric

d. Normal, because the lower back and leg muscles are not yet well developed

ANS: D

Rationale:
Genu varum (bowlegged) is common in toddlers when they begin to walk. It usually persists until all of their lower back and leg muscles are well developed.

Kimberly is having a checkup before starting kindergarten. The nurse asks her to do the finger-to-nose test. The nurse is testing for

a. Deep tendon reflexes

b. Cerebellar function

c. Sensory discrimination

d. Ability to follow directions

ANS: B

Rationale: The finger-to-nose-test is an indication of cerebellar function. This test checks balance and coordination.

Which statement about performing a pediatric physical assessment is correct for a school-age child? Select all that apply.

a. Physical examinations proceed systematically from head to toe.

b. The physical examination should be done with parents in the waiting room.

c. Measurement of head circumference is obtained.

d. The physical examination is done only when the child is cooperative.

e. Remove clothing and have the child put on an examination gown.

ANS: A, D, E

Rationale: Correct- Physical assessment usually proceeds from head to toe; however if developmental delays exist, considerations dictate that the least threatening assessments be done first to obtain accurate data. School-age children are at a developmental stage when they should be cooperative for the physical examination. Children of this age are usually modest, and an examination gown should be provided.

Incorrect- Having parents in the examining room with adolescents is not appropriate, but is appropriate for children of other age-groups. Parents usually are not kept in the waiting room. Measurement of head circumference is obtained on children 36 months of age or less.

What should the nurse recognize as a possible indicator of child abuse in a 4-year-old child being treated for ear pain at the emergency department on a chilly Christmas Day in New York State? Select all that apply.

a. The child extends his arms to be hugged by the nurse.

b. The child is wearing clean, baggy shorts, sandals, and an oversized T-shirt.

c. The child answers all questions in complete sentences, and smiles afterward.

d. The child has dirty, broken teeth.

e. The child states Im so fat when the nurse tells his mother he weighs 25 lb.

ANS: B, D, E

Rationale: Correct- These clothes are inappropriate attire for December in New York State. Even though the clothes are clean, dressing inappropriately for the weather is a potential indicator of child abuse. Clothing that is too large or small for the childs size also requires further evaluation. Dirty, broken teeth are an indicator of potential child abuse. A child who is 4 years old and weighs only 25 lb is thin for his age. Body image distortion (being thin but describing self as fat) is a potential indicator of child abuse. A child who is too thin for his height should also be further evaluated.

Incorrect- Although it may be unusual for this child to want to hugged by the nurse, it is not an indicator of child abuse. Answering questions using complete sentences and smiling is appropriate for a 4-year-old.

A nurse is performing an assessment on a newborn. Which vital signs indicate a normal finding for this age group? Select all that apply.

a. Pulse of 80125 a minute

b. B/P of systolic 6595 and diastolic 3060

c. Temperature of 36.537.3 Celsius (axillary)

d. Temperature of 36.437 Celsius (axillary)

e. Respirations of 3060 a minute

ANS: B, C, E

Rationale: Correct- The normal vital signs for a newborn are temperature 36.5 to 37.3 Celsius (axillary), pulse rate of 120160 a minute, respiratory rate of 3060 a minute, systolic B/P of 6595, and diastolic B/P of 3062. A temperature of 36.437 Celsius is normal for an older child. A pulse rate of 80125 is normal for a 4-year-old child.

Incorrect- A pulse rate of 80125 per minute and temperature of 36.437 C are both too low for a well-newborn.

A school nurse is screening children for scoliosis. Which assessment findings should the nurse expect to observe for scoliosis? Select all that apply.

a. Pain with deep palpation of the spinal column

b. Unequal shoulder heights

c. The trouser pant leg length appears shorter on one side

d. Inability to bend at the waist

e. Unequal waist angles

ANS: B, C, E

Rationale: Correct- The assessment findings associated with scoliosis include unequal shoulder heights, trouser pant leg length appearing shorter on one side meaning unequal leg length, and unequal waist angles.

Incorrect- Scoliosis is a nonpainful curvature of the spine so pain is not expected and the child is able to bend at the waist adequately.

The parents of a preschool child ask the nurse why their child needs to have her eyes tested. The nurse explains that although evaluating the visual acuity in a young child can be difficult, the American Academy of Pediatric recommends that visual acuity testing be assessed on all children beginning no later than age \_________ years.

3

Rationale: The American Academy of Pediatric recommends that visual acuity testing be assessed on all children beginning no later than age 3 years. Tools available for testing the visual acuity of preschool children include Lea cards, tumbling Es, and the HOTV chart.